ORIGINAL

1. Goods Consigned from (Exporter’s name, address and Certificate No. Form AANZ
country)
AGREEMENT ESTABLISHING THE ASEAN –
AUSTRALIA – NEW ZEALAND FREE TRADE
AREA (AANZFTA)

2. Goods Consigned to (Importer’s/ Consignee’s name, CERTIFICATE OF ORIGIN

address, country) (Combined Declaration and Certificate)

Issued in VIET NAM

(Country)
(see Overleaf Notes)

3. Means of transport and route (if known) 4. For Official Use

 Preferential Treatment Given Under AANZFTA

Shipment Date: ____________________________________________________

 Preferential Treatment Not Given (Please state

reason/s)
Vessel’s name/Aircraft etc.: ____________________________________________________

Port of Discharge:
……….…………………………………………………………………………
Signature of Authorised Signatory of the Importing Country
5. Item 6. Marks and 7. Number and kind of packages; 8. Origin 9. Quantity (Gross weight or 10. Invoice
number numbers on description of goods including Conferring other measurement), and number(s)
packages HS Code (6 digits) and brand Criterion (see value (FOB) where RVC is and date of
name (if applicable). Name of Overleaf Notes) applied (see Overleaf Notes) invoice(s)
company issuing third party
invoice (if applicable)

11. Declaration by the exporter 12. Certification

The undersigned hereby declares that the above details On the basis of control carried out, it is hereby certified that the
and statements are correct; that all the goods were information herein is correct and that the goods described comply
produced in with the origin requirements specified in the Agreement Establishing
the ASEAN – Australia - New Zealand Free Trade Area.

……….…………………………………………………..…………………….……
(country)
and that they comply with the rules of origin, as provided
in Chapter 3 of the Agreement Establishing the ASEAN -
Australia - New Zealand Free Trade Area for the goods
exported to

……….…………………………………………………..…………………………………
(importing country)

……….…………………………………………………..………………………………… ……….…………………………………………………..…………………………………
Place and date, name, signature and company of authorised Place and date, signature and stamp of Authorised Issuing
signatory Authority/Body
13.  Back-to-back Certificate of Origin  Subject of third-party invoice  Issued retroactively
 De Minimis  Accumulation
 OVERLEAF NOTES

1. Countries which accept this form for the purpose of preferential treatment under the Agreement Establishing the ASEAN-Australia-New Zealand
Free Trade Area (the Agreement):
Australia Brunei Darussalam Cambodia Indonesia Lao PDR Malaysia
Myanmar New Zealand Philippines Singapore Thailand Viet Nam
(herein after individually referred to as a Party)

2. CONDITIONS: To be eligible for the preferential treatment under the AANZFTA, goods must:
a. Fall within a description of products eligible for concessions in the importing Party;
b. Comply with all relevant provisions of Chapter 3 (Rules of Origin) of the Agreement.

3. EXPORTER AND CONSIGNEE: Details of the exporter of the goods (including name, address and country) and consignee (name and address)
must be provided in Box 1 and Box 2, respectively.

4. DESCRIPTION OF GOODS: The description of each good in Box7 must include the Harmonized Commodity Description and Coding System
(HS) subheading at the 6-digit level of the exported product, and if applicable, product name and brand name. This information should be
sufficiently detailed to enable the products to be identified by the customs officer examining them.

5. ORIGIN CRITERIA: For the goods that meet the origin criteria, the exporter should indicate in Box8of this Form, the origin criteria met, in the
manner shown in the following table:

Circumstances of production or manufacture in the country named in Box11of this form: Insert in Box8

(a) Goods wholly produced or obtained satisfying Article 2.1(a) of Chapter 3 of the Agreement WO

(b) Goods produced entirely satisfying Article 2.1(c) of Chapter 3 of the Agreement PE
(c) Not wholly produced or obtained in a Party, provided that the goods satisfy Article 4of Chapter 3 of the
Agreement as amended by the First Protocol i.e., if the good is specified in Annex 2, all the product specific
requirements listed have been met:

- Change in Tariff Classification CTC

- Regional Value Content RVC

- Regional Value Content + Change in Tariff Classification “e.g. CTSH + RVC 35%”
- Other, including a Specific Manufacturing or Processing Operation Other

6. EACH GOOD CLAIMING PREFERENTIAL TARIFF TREATMENT MUST QUALIFY IN ITS OWN RIGHT: It should be noted that all the goods
in a consignment must qualify separately in their own right. This is of particular relevance when similar articles of different sizes or spare parts
are exported.

7. FOB VALUE: For Consignments to all Parties where the origin criteria includes a Regional Value Content requirement:
 An exporter from an ASEAN Member State must provide in Box 9 the FOB value of the goods
 An exporter from Australia or New Zealand can complete either Box 9 or provide a separate “Exporter Declaration” stating the FOB value of
the goods.

The FOB value is not required for consignments where the origin criteria does not include a Regional Value Content requirement. In the case of
goods exported from and imported by Cambodia and Myanmar, the FOB value shall be included in the Certificate of Origin or the back-to-back
Certificate of Origin for all goods, irrespective of the origin criteria used, for two (2) years from the date of entry into force of the First Protocol or
an earlier date as endorsed by the Committee on Trade in Goods.

8. INVOICES: Indicate the invoice number and date for each item. The invoice should be the one issued for the importation of the good into the
importing Party.

9. SUBJECT OF THIRD PARTY INVOICE: In cases where invoices used for the importation are issued in a third country, in accordance with Rule
22 of the Operational Certification Procedures, the “SUBJECT OF THIRD-PARTY INVOICE” box in Box 13should be ticked ()and the name of
the company issuing the invoice should be provided in Box 7or, if there is insufficient space, on a continuation sheet. The number of the invoices
issued by the manufacturers or the exporters and the number of the invoices issued by the trader (if known) for the importation of goods into the
importing Party should be indicated in Box 10.

10. BACK-TO-BACK CERTIFICATE OF ORIGIN: In the case of a back-to-back certificate of origin issued in accordance with paragraph 3 of Rule 10
of the Operational Certification Procedures, the back-to-back certificate of origin in Box 13should be ticked ().

11. CERTIFIED TRUE COPY: In case of a certified true copy, the words “CERTIFIED TRUE COPY” should be written or stamped on Box 12of the
Certificate with the date of issuance of the copy in accordance with Rule 11 of the Operational Certification Procedures.

12. FOR OFFICIAL USE: The Customs Authority of the Importing Party must indicate () in the relevant boxes in Box4 whether or not preferential
tariff treatment is accorded.

13. BOX 13:The items in Box 13 should be ticked (), as appropriate,in those cases where such items are relevant to the goods covered by the
Certificate.
 DUPLICATE
1. Goods Consigned from (Exporter’s name, address and Certificate No. Form AANZ
country)
AGREEMENT ESTABLISHING THE ASEAN –
AUSTRALIA – NEW ZEALAND FREE TRADE
AREA (AANZFTA)

2. Goods Consigned to (Importer’s/ Consignee’s name, CERTIFICATE OF ORIGIN

address, country) (Combined Declaration and Certificate)

Issued in VIET NAM

(Country)
(see Overleaf Notes)

3. Means of transport and route (if known) 4. For Official Use

 Preferential Treatment Given Under AANZFTA

Shipment Date: ____________________________________________________

 Preferential Treatment Not Given (Please state

reason/s)
Vessel’s name/Aircraft etc.: ____________________________________________________

Port of Discharge:
……….…………………………………………………………………………
Signature of Authorised Signatory of the Importing Country
5. Item 6. Marks and 7. Number and kind of packages; 8. Origin 9. Quantity (Gross weight or 10. Invoice
number numbers on description of goods including Conferring other measurement), and number(s)
packages HS Code (6 digits) and brand Criterion (see value (FOB) where RVC is and date of
name (if applicable). Name of Overleaf Notes) applied (see Overleaf Notes) invoice(s)
company issuing third party
invoice (if applicable)

11. Declaration by the exporter 12. Certification

The undersigned hereby declares that the above details On the basis of control carried out, it is hereby certified that the
and statements are correct; that all the goods were information herein is correct and that the goods described comply
produced in with the origin requirements specified in the Agreement Establishing
the ASEAN – Australia - New Zealand Free Trade Area.

……….…………………………………………………..…………………….……
(country)
and that they comply with the rules of origin, as provided
in Chapter 3 of the Agreement Establishing the ASEAN -
Australia - New Zealand Free Trade Area for the goods
exported to

……….…………………………………………………..…………………………………
(importing country)

……….…………………………………………………..………………………………… ……….…………………………………………………..…………………………………
Place and date, name, signature and company of authorised Place and date, signature and stamp of Authorised Issuing
signatory Authority/Body
13.  Back-to-back Certificate of Origin  Subject of third-party invoice  Issued retroactively
 De Minimis  Accumulation
 OVERLEAF NOTES

1. Countries which accept this form for the purpose of preferential treatment under the Agreement Establishing the ASEAN-Australia-New Zealand
Free Trade Area (the Agreement):
Australia Brunei Darussalam Cambodia Indonesia Lao PDR Malaysia
Myanmar New Zealand Philippines Singapore Thailand Viet Nam
(herein after individually referred to as a Party)

2. CONDITIONS: To be eligible for the preferential treatment under the AANZFTA, goods must:
a. Fall within a description of products eligible for concessions in the importing Party;
b. Comply with all relevant provisions of Chapter 3 (Rules of Origin) of the Agreement.

3. EXPORTER AND CONSIGNEE: Details of the exporter of the goods (including name, address and country) and consignee (name and address)
must be provided in Box 1 and Box 2, respectively.

4. DESCRIPTION OF GOODS: The description of each good in Box7 must include the Harmonized Commodity Description and Coding System
(HS) subheading at the 6-digit level of the exported product, and if applicable, product name and brand name. This information should be
sufficiently detailed to enable the products to be identified by the customs officer examining them.

5. ORIGIN CRITERIA: For the goods that meet the origin criteria, the exporter should indicate in Box8of this Form, the origin criteria met, in the
manner shown in the following table:

Circumstances of production or manufacture in the country named in Box11of this form: Insert in Box8

(d) Goods wholly produced or obtained satisfying Article 2.1(a) of Chapter 3 of the Agreement WO

(e) Goods produced entirely satisfying Article 2.1(c) of Chapter 3 of the Agreement PE
(f) Not wholly produced or obtained in a Party, provided that the goods satisfy Article 4of Chapter 3 of the
Agreement as amended by the First Protocol i.e., if the good is specified in Annex 2, all the product specific
requirements listed have been met:

- Change in Tariff Classification CTC

- Regional Value Content RVC

- Regional Value Content + Change in Tariff Classification “e.g. CTSH + RVC 35%”
- Other, including a Specific Manufacturing or Processing Operation Other

6. EACH GOOD CLAIMING PREFERENTIAL TARIFF TREATMENT MUST QUALIFY IN ITS OWN RIGHT: It should be noted that all the goods
in a consignment must qualify separately in their own right. This is of particular relevance when similar articles of different sizes or spare parts
are exported.

7. FOB VALUE: For Consignments to all Parties where the origin criteria includes a Regional Value Content requirement:
 An exporter from an ASEAN Member State must provide in Box 9 the FOB value of the goods
 An exporter from Australia or New Zealand can complete either Box 9 or provide a separate “Exporter Declaration” stating the FOB value of
the goods.

The FOB value is not required for consignments where the origin criteria does not include a Regional Value Content requirement. In the case of
goods exported from and imported by Cambodia and Myanmar, the FOB value shall be included in the Certificate of Origin or the back-to-back
Certificate of Origin for all goods, irrespective of the origin criteria used, for two (2) years from the date of entry into force of the First Protocol or
an earlier date as endorsed by the Committee on Trade in Goods.

8. INVOICES: Indicate the invoice number and date for each item. The invoice should be the one issued for the importation of the good into the
importing Party.

9. SUBJECT OF THIRD PARTY INVOICE: In cases where invoices used for the importation are issued in a third country, in accordance with Rule
22 of the Operational Certification Procedures, the “SUBJECT OF THIRD-PARTY INVOICE” box in Box 13should be ticked ()and the name of
the company issuing the invoice should be provided in Box 7or, if there is insufficient space, on a continuation sheet. The number of the invoices
issued by the manufacturers or the exporters and the number of the invoices issued by the trader (if known) for the importation of goods into the
importing Party should be indicated in Box 10.

10. BACK-TO-BACK CERTIFICATE OF ORIGIN: In the case of a back-to-back certificate of origin issued in accordance with paragraph 3 of Rule 10
of the Operational Certification Procedures, the back-to-back certificate of origin in Box 13should be ticked ().

11. CERTIFIED TRUE COPY: In case of a certified true copy, the words “CERTIFIED TRUE COPY” should be written or stamped on Box 12of the
Certificate with the date of issuance of the copy in accordance with Rule 11 of the Operational Certification Procedures.

12. FOR OFFICIAL USE: The Customs Authority of the Importing Party must indicate () in the relevant boxes in Box4 whether or not preferential
tariff treatment is accorded.

13. BOX 13:The items in Box 13 should be ticked (), as appropriate,in those cases where such items are relevant to the goods covered by the
Certificate.
 TRIPLICATE
1. Goods Consigned from (Exporter’s name, address and Certificate No. Form AANZ
country)
AGREEMENT ESTABLISHING THE ASEAN –
AUSTRALIA – NEW ZEALAND FREE TRADE
AREA (AANZFTA)

2. Goods Consigned to (Importer’s/ Consignee’s name, CERTIFICATE OF ORIGIN

address, country) (Combined Declaration and Certificate)

Issued in VIET NAM

(Country)
(see Overleaf Notes)

3. Means of transport and route (if known) 4. For Official Use

 Preferential Treatment Given Under AANZFTA

Shipment Date: ____________________________________________________

 Preferential Treatment Not Given (Please state

reason/s)
Vessel’s name/Aircraft etc.: ____________________________________________________

Port of Discharge:
……….…………………………………………………………………………
Signature of Authorised Signatory of the Importing Country
5. Item 6. Marks and 7. Number and kind of packages; 8. Origin 9. Quantity (Gross weight or 10. Invoice
number numbers on description of goods including Conferring other measurement), and number(s)
packages HS Code (6 digits) and brand Criterion (see value (FOB) where RVC is and date of
name (if applicable). Name of Overleaf Notes) applied (see Overleaf Notes) invoice(s)
company issuing third party
invoice (if applicable)

11. Declaration by the exporter 12. Certification

The undersigned hereby declares that the above details On the basis of control carried out, it is hereby certified that the
and statements are correct; that all the goods were information herein is correct and that the goods described comply
produced in with the origin requirements specified in the Agreement Establishing
the ASEAN – Australia - New Zealand Free Trade Area.

……….…………………………………………………..…………………….……
(country)
and that they comply with the rules of origin, as provided
in Chapter 3 of the Agreement Establishing the ASEAN -
Australia - New Zealand Free Trade Area for the goods
exported to

……….…………………………………………………..…………………………………
(importing country)

……….…………………………………………………..………………………………… ……….…………………………………………………..…………………………………
Place and date, name, signature and company of authorised Place and date, signature and stamp of Authorised Issuing
signatory Authority/Body
13.  Back-to-back Certificate of Origin  Subject of third-party invoice  Issued retroactively
 De Minimis  Accumulation
 OVERLEAF NOTES

1. Countries which accept this form for the purpose of preferential treatment under the Agreement Establishing the ASEAN-Australia-New Zealand
Free Trade Area (the Agreement):
Australia Brunei Darussalam Cambodia Indonesia Lao PDR Malaysia
Myanmar New Zealand Philippines Singapore Thailand Viet Nam
(herein after individually referred to as a Party)

2. CONDITIONS: To be eligible for the preferential treatment under the AANZFTA, goods must:
a. Fall within a description of products eligible for concessions in the importing Party;
b. Comply with all relevant provisions of Chapter 3 (Rules of Origin) of the Agreement.

3. EXPORTER AND CONSIGNEE: Details of the exporter of the goods (including name, address and country) and consignee (name and address)
must be provided in Box 1 and Box 2, respectively.

4. DESCRIPTION OF GOODS: The description of each good in Box7 must include the Harmonized Commodity Description and Coding System
(HS) subheading at the 6-digit level of the exported product, and if applicable, product name and brand name. This information should be
sufficiently detailed to enable the products to be identified by the customs officer examining them.

5. ORIGIN CRITERIA: For the goods that meet the origin criteria, the exporter should indicate in Box8of this Form, the origin criteria met, in the
manner shown in the following table:

Circumstances of production or manufacture in the country named in Box11of this form: Insert in Box8

(g) Goods wholly produced or obtained satisfying Article 2.1(a) of Chapter 3 of the Agreement WO

(h) Goods produced entirely satisfying Article 2.1(c) of Chapter 3 of the Agreement PE
(i) Not wholly produced or obtained in a Party, provided that the goods satisfy Article 4of Chapter 3 of the
Agreement as amended by the First Protocol i.e., if the good is specified in Annex 2, all the product specific
requirements listed have been met:

- Change in Tariff Classification CTC

- Regional Value Content RVC

- Regional Value Content + Change in Tariff Classification “e.g. CTSH + RVC 35%”

- Other, including a Specific Manufacturing or Processing Operation Other

6. EACH GOOD CLAIMING PREFERENTIAL TARIFF TREATMENT MUST QUALIFY IN ITS OWN RIGHT: It should be noted that all the goods
in a consignment must qualify separately in their own right. This is of particular relevance when similar articles of different sizes or spare parts
are exported.

7. FOB VALUE: For Consignments to all Parties where the origin criteria includes a Regional Value Content requirement:
 An exporter from an ASEAN Member State must provide in Box 9 the FOB value of the goods
 An exporter from Australia or New Zealand can complete either Box 9 or provide a separate “Exporter Declaration” stating the FOB value of
the goods.

The FOB value is not required for consignments where the origin criteria does not include a Regional Value Content requirement. In the case of
goods exported from and imported by Cambodia and Myanmar, the FOB value shall be included in the Certificate of Origin or the back-to-back
Certificate of Origin for all goods, irrespective of the origin criteria used, for two (2) years from the date of entry into force of the First Protocol or
an earlier date as endorsed by the Committee on Trade in Goods.

8. INVOICES: Indicate the invoice number and date for each item. The invoice should be the one issued for the importation of the good into the
importing Party.

9. SUBJECT OF THIRD PARTY INVOICE: In cases where invoices used for the importation are issued in a third country, in accordance with Rule
22 of the Operational Certification Procedures, the “SUBJECT OF THIRD-PARTY INVOICE” box in Box 13should be ticked ()and the name of
the company issuing the invoice should be provided in Box 7or, if there is insufficient space, on a continuation sheet. The number of the invoices
issued by the manufacturers or the exporters and the number of the invoices issued by the trader (if known) for the importation of goods into the
importing Party should be indicated in Box 10.

10. BACK-TO-BACK CERTIFICATE OF ORIGIN: In the case of a back-to-back certificate of origin issued in accordance with paragraph 3 of Rule 10
of the Operational Certification Procedures, the back-to-back certificate of origin in Box 13should be ticked ().

11. CERTIFIED TRUE COPY: In case of a certified true copy, the words “CERTIFIED TRUE COPY” should be written or stamped on Box 12of the
Certificate with the date of issuance of the copy in accordance with Rule 11 of the Operational Certification Procedures.

12. FOR OFFICIAL USE: The Customs Authority of the Importing Party must indicate () in the relevant boxes in Box4 whether or not preferential
tariff treatment is accorded.

13. BOX 13:The items in Box 13 should be ticked (), as appropriate,in those cases where such items are relevant to the goods covered by the
Certificate.